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Pharyngitis

Pharyngitides

Pharyngitis is defined as an infection or inflammation of the pharynx which is common in children.


Presentation

Symptoms usually vary depending on whether it is a viral or bacterial infection. They may also vary from mild to severe.

In case of viral pharyngitis, the symptoms include the following:

Patients suffering from bacterial pharyngitis usually present with the following features:

  • Fever
  • Body ache
  • Generalized body sickness
  • Enlarged tonsils with white spots
  • Swollen, tender lymph nodes in front of the neck
  • Edema, erythema and lymphoid hyperplasia may also be present.

Children usually present with diarrhea, loss of appetite, conjunctivitis, cough, and fever as high as 105 F [5]. In severe cases, there may be dysphagia for fluids and even for saliva [6].

Patients with fungal infections present with oral thrush in most of the cases.

Cervical Lymphadenopathy
  • On physical exam, she has anterior cervical lymphadenopathy and patchy tonsillar exudates and swelling. A rapid antigen detection test is positive for group A streptococcus infection, which prompted treatment with penicillin V.[medbullets.com]
  • Posterior cervical lymphadenopathy is common in patients with infectious mononucleosis, and its absence makes the diagnosis much less likely.[aafp.org]
  • One of the most commonly used scoring system is the Centor Score , assigning points for tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough and history of fever.[rhdaction.org]
  • The Centor criteria have been used in the past as a way to diagnose and treat GAS pharyngitis. 6 These include the following: Fever Anterior cervical lymphadenopathy Tonsillar exudate Absence of cough One point is awarded for each of the criteria met,[web.archive.org]
Fever
  • Temperature: Fever is usually absent or low-grade in viral pharyngitis, but fever is not reliable to differentiate viral or bacterial etiologies.[web.archive.org]
  • OBJECTIVE: Periodic fever, aphthosis, pharyngitis, and adenitis (PFAPA) syndrome is a periodic fever syndrome of childhood with an unknown etiology.[ncbi.nlm.nih.gov]
  • Most of these children have undergone workup(s) for sepsis performed by their pediatricians because of the associated high fever. The clinical history of this cohort was quite distinctive.[ncbi.nlm.nih.gov]
  • We report three familial cases of periodic fever with aphthous stomatitis, pharyngitis, and cervical adenitis syndrome, including a pair of monozygotic twins and their mother.[ncbi.nlm.nih.gov]
  • On physical examination fever (39.2 degrees C), exudative pharyngitis, tenderness and swelling in the left anterior cervical area were noted.[ncbi.nlm.nih.gov]
Chills
  • In addition to a sore, dry, or scratchy throat , a cold or flu may cause: sneezing runny nose headache cough fatigue body aches chills fever (a low-grade fever with a cold and higher-grade fever with the flu) In addition to a sore throat, the symptoms[healthline.com]
  • A 27-year-old woman complains of 2 days of sore throat, fever, and chills. She is unable to swallow anything other than liquids because of severe odynophagia. She denies any congestion or cough.[accessmedicine.mhmedical.com]
  • If pharyngitis is caused by the common cold then symptoms will include: Cough Sneezing Headache Raised temperature (mild) Pharyngitis as part of influenza (or ‘the flu’) will include the following symptoms: Aches and pains Fever Chills Extreme tiredness[medic8.com]
  • Symptoms Signs and symptoms of pharyngitis include: Sore throat Fever If tonsillitis occurs, you will experience: Severe sore throat Painful and difficult swallowing Referred pain to the ear Fever and chills Loss of voice (due to inflammation of voice[singhealth.com.sg]
Pharyngitis
  • […] chronic pharyngitis chronic pharyngitis and nasopharyngitis chronic sore throat pharyngeal disease inflamed throat throatitis Sore Throat throat inflammation edit English pharyngitis type of upper respiratory tract infection Persistent sore throat Pharyngeal[wikidata.org]
  • Airway obstruction is also of utmost importance for the ED physician treating pharyngitis. Pathophysiology With infectious pharyngitis, bacteria or viruses may directly invade the pharyngeal mucosa, causing a local inflammatory response.[web.archive.org]
  • BACKGROUND: Group A streptococcus (GAS) is the most common bacterial etiology of pharyngitis but is difficult to distinguish clinically from viral pharyngitis.[ncbi.nlm.nih.gov]
  • Prevalence estimates for GAS ve pharyngitis, serologically-confirmed GAS pharyngitis and asymptomatic pharyngeal carriage were generated. Findings were stratified by age group, recruitment method and country income level.[ncbi.nlm.nih.gov]
Sore Throat
  • From Wikidata Jump to navigation Jump to search type of upper respiratory tract infection Persistent sore throat Pharyngeal disorder Pharyngitis - acute Sore throat - chronic acute pharyngitis acute sore throat acute sore throat NOS chronic pharyn/nasopharyngitis[wikidata.org]
  • RESULTS: A total of 101 patients with sore throat were tested with 26 (25.7%) positive for GAS. One hundred and forty-seven patients without sore throat were tested with one positive POC test result (specificity 99%; 95% CI 96-100).[ncbi.nlm.nih.gov]
  • […] right away if you have a sore throat and trouble breathing.[nlm.nih.gov]
Cough
  • Patients often have a cough. Occasional outbreaks have been reported. M pneumoniae in young adults presents with headache, pharyngitis, and lower respiratory symptoms.[web.archive.org]
  • Other common symptoms include fever, swollen lymph nodes in the neck, cough, headache, pain in the ears and hoarseness. The treatment depends on the cause.[symptoma.com]
  • Other symptoms may include a runny nose, cough, headache, and a hoarse voice. Symptoms usually last three to five days. Complications can include sinusitis and acute otitis media.[en.wikipedia.org]
  • She then developed a left neck swelling, followed by difficult swallowing and cough. Subsequently, she developed shortness of breath that became severe.[ncbi.nlm.nih.gov]
  • […] spaces Using correct coughing and sneezing technique, such as coughing or sneezing into a tissue and disposing it, or into the inner side of the upper arm Do not share food or drinks with infected individuals Regularly clean the sleeping and living areas[dovemed.com]
Tonsillar Hypertrophy
  • On clinical examination, patients with group A strep pharyngitis usually have Pharyngeal and tonsillar erythema Tonsillar hypertrophy with or without exudates Palatal petechiae Anterior cervical lymphadenopathy Patients with group A strep pharyngitis[cdc.gov]
Stridor
  • If stridor is present, consider a foreign body or epiglottitis. If the patient is drooling, the patient may be in severe pain, or consider a foreign body or epiglottitis. If the voice is abnormal, consider several processes.[cdemcurriculum.com]
Tonsillar Exudate
  • PATIENTS AND METHODS: 50 patients presenting sore throat associated with erythema and/or pharyngeal tonsillar exudate with or without scarlatiniform rash, fever and malaise had been subjected to perform a rapid test (RAD: Rapid antigen detection) for[ncbi.nlm.nih.gov]
  • Figure 35-1 Strep pharyngitis showing tonsillar exudate and erythema. ( Courtesy of Michael Nguyen, MD .) Pharyngitis is inflammation of the pharyngeal tissues, and is usually associated with pain.[accessmedicine.mhmedical.com]
  • On physical exam, she has anterior cervical lymphadenopathy and patchy tonsillar exudates and swelling. A rapid antigen detection test is positive for group A streptococcus infection, which prompted treatment with penicillin V.[medbullets.com]
  • The original model designated four criteria: tonsillar exudates, swollen tender anterior cervical nodes, absence of a cough, and history of fever.[mdcalc.com]
  • Based on 5 clinical criteria, it indicates the probability of a streptococcal infection.One point is given for each of the criteria: Absence of a cough Swollen and tender cervical lymph nodes Temperature more than 38.0 C (100.4 F) Tonsillar exudate or[en.wikipedia.org]
Palatal Petechiae
  • Tonsillopharyngeal/palatal petechiae are seen in GAS infections and infectious mononucleosis.[web.archive.org]
  • On clinical examination, patients with group A strep pharyngitis usually have Pharyngeal and tonsillar erythema Tonsillar hypertrophy with or without exudates Palatal petechiae Anterior cervical lymphadenopathy Patients with group A strep pharyngitis[cdc.gov]
  • Physical examination includes the following: Assessment of airway patency Temperature Hydration status Head, ears, eyes, nose, and throat – Conjunctivitis, scleral icterus, rhinorrhea, tonsillopharyngeal/palatal petechiae, tonsillopharyngeal exudate,[emedicine.com]
Exudative Pharyngitis
  • On physical examination fever (39.2 degrees C), exudative pharyngitis, tenderness and swelling in the left anterior cervical area were noted.[ncbi.nlm.nih.gov]
  • Marvez-Valls EG, Ernst AA, Gray J, Johnson WD (1998) The role of betamethasone in the treatment of acute exudative pharyngitis. Acad Emerg Med 5:567–572 PubMed CrossRef Google Scholar 24.[doi.org]
  • Exudative pharyngitis is prominent. Distinctive features include retrocervical or generalized adenopathy and hepatosplenomegaly. Atypical lymphocytes can be seen on peripheral blood smear.[web.archive.org]
  • Clinical efficacy of dexamethasone for acute exudative pharyngitis. J Emerg Med . 2008 Nov. 35(4):363-7. [Medline] . Shephard A, Smith G, Aspley S, et al.[emedicine.com]
Erythema
  • On examination, she has bilateral tonsillar erythema and exudate ( Figure 35-1 ). Her anterior cervical lymph nodes are tender.[accessmedicine.mhmedical.com]
  • PATIENTS AND METHODS: 50 patients presenting sore throat associated with erythema and/or pharyngeal tonsillar exudate with or without scarlatiniform rash, fever and malaise had been subjected to perform a rapid test (RAD: Rapid antigen detection) for[ncbi.nlm.nih.gov]
  • HIV-1: This is associated with pharyngeal edema and erythema, common aphthous ulcers, and a rarity of exudates. Fever, myalgia, and lymphadenopathy also are found.[web.archive.org]
  • The pharynx should be examined for erythema, hypertrophy, foreign body, exudates, masses, petechiae, and adenopathy. It also is important to assess the patient for fever, rash, cervical adenopathy, and coryza.[aafp.org]
  • Abdominal pain Runny nose Patients suffering from bacterial pharyngitis usually present with the following features: Fever Body ache Generalized body sickness Enlarged tonsils with white spots Swollen, tender lymph nodes in front of the neck Edema, erythema[symptoma.com]
Headache
  • RESULTS: In patients from Turkey, symptom onset was at a younger age, fever attacks were of shorter duration, and pharyngitis was more frequent, whereas adenitis, headache, and nausea/vomiting were less frequent during attacks, when compared to patients[ncbi.nlm.nih.gov]
  • Take paracetamol, ibuprofen or aspirin to ease any pain and other symptoms such as a headache. Do NOT give aspirin to children under 16.[medic8.com]
  • They cause fever, headache, and sore throat that last for 4 to 14 days. Lymphatic tissue in the pharynx may also become involved.[britannica.com]
  • M pneumoniae in young adults presents with headache, pharyngitis, and lower respiratory symptoms. Approximately 75% of patients have a cough, which is distinctive from GAS infection.[web.archive.org]
  • Other symptoms may include a runny nose, cough, headache, and a hoarse voice. Symptoms usually last three to five days. Complications can include sinusitis and acute otitis media.[en.wikipedia.org]

Workup

A complete history with thorough examination of the mouth, throat, nose, ears and lymph nodes in front of the neck is necessary. It is hard to differentiate between a viral and bacterial cause based on symptoms alone; however, Centor criteria is helpful in the diagnosis of streptococcal pharyngitis [7] [8].

The following investigations are necessary to establish the diagnosis.

  • White blood cell (WBC) count will be raised with predominance of polymorphs.
  • Throat culture is the primary method for the diagnosis of streptococcal pharyngitis and the most reliable means of differentiating streptococcal from viral pharyngitis.
  • Non-specific tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are of very little importance [9].

Treatment

The majority of time treatment is symptomatic. Specific treatments are effective for bacterial, viral and fungal infections.

Medications

Antibiotics: The treatment of choice for streptococcal pharyngitis is oral penicillin V (250mg) given 3 times daily for 10 days. This is helpful if bacterial infection is the cause of sore throat [10]. Antibiotics have no effect for a viral infection. Non-compliant patients may be given a single intramuscular injection of benzathine penicillin G, which provides adequate penicillin levels for 10 days. The usual dose is 600,000 units for children weighing less than 25 kg and 1,200,000 units for children weighing 25 kg or more.

Penicillin-allergic patients may be given any of the several alternative antibiotics:

  • Oral erythromycin (50 mg/kg/day in three divided doses for 10 days). Or
  • Oral cephalosporins such as cephradin or cephalexin (50-100 mg/kg/day in three divided doses for 10 days). Or
  • Oral clarithromycin (15 mg/kg/day in two divided doses for 10 days).

If the patient has had three or more documented infections within 6 months, consider daily penicillin prophylaxis during the winter season.

Analgesics: They help reduce soreness of the throat. Most effective analgesics include non-steroidal anti-inflammatory drugs and acetaminophen.

Steroids: They are helpful in severe pharyngitis. Dexamethasone is often used for this purpose.

Idocaine: It helps to relieve pain by numbing the mucous membrane.

Surgery

Surgery should be considered when the patients have frequent episodes of pharyngitis or when the persistently enlarged tonsils cause chronic upper airway obstruction.

Prognosis

Almost all the people with viral and bacterial streptococcal pharyngitis recover completely without complications; so the overall the prognosis is excellent. Streptococcal infection of the throat should always be treated carefully as untreated cases may develop rheumatic fever [4].

Etiology

There can be infectious or non-infectious causes of pharyngitis.

Infectious

Acute pharyngitis is an oropharyngeal infection. The disease most commonly spreads via contact with infected individuals and droplet infection. The infectious agents may be bacterial, viral or fungal in nature [1].

Viral: These comprise about 40-60% of all the infectious cases. The different kinds of viruses include:

Bacterial: The different kinds of bacteria include:

  • Streptococci: Group A beta-hemolytic streptococc are the most common bacterial cause of acute pharyngitis. Common symptoms include fever, sore throat and large lymph nodes.
  • Fusobacterium necrophorum: These organism are normal inhabitants of oropharyngeal flora. However, they may cause peritonsillar abscess in some cases [2].
  • Diphtheria: This is a life threatening upper respiratory infection caused by Corynebacteria diphtheria.

Fungal: Sometimes, the oral thrush caused by Candida albicans may extend to involve the pharynx.

Non-infectious

Non-infectious cases of acute pharyngitis result from mechanical, chemical or thermal irritation including cold air or acid reflux. Neoplastic conditions can also cause pharyngitis [3].

Epidemiology

Streptococcal pharyngitis is one of the most common respiratory infections of the childhood. The disease is uncommon under the age of 1 year. The peak incidence occurs in children between the age of 5 and 15 years. Pharyngitis in children younger than 2 years of age is often viral. The incidence is higher in the winter and early spring. It is estimated that it affects more than 1.9 million people a year.

Sex distribution
Age distribution

Pathophysiology

Etiologic agents may directly invade or cause irritation to the pharyngeal mucosa, resulting in localized inflammatory reaction or cause secondary irritation.

Prevention

The following are the known ways of preventing pharyngitis.

  • Frequent washing of the hands.
  • Avoidance of the sharing of eating utensils or cups with anyone who has a sore throat, flu, common cold or bacterial infection.
  • Avoiding both active and passive smoking.
  • Using a humidifier if the surrounding air is dry.
  • Using vitamin C supplements may also be helpful as it improves components of human immune system such as natural killer cell activity.
  • Supplementation of zinc may also be essential as it may be involved directly in antibody production to help you fight infections.

Summary

Pharyngitis is the inflammation of the pharynx commonly caused by upper airway infection. The disease can be acute or chronic. In most of the cases, it is quite painful and results in enlarging of the tonsils which cause trouble in swallowing or even in breathing. Due to systemic infection, it may also be associated with cough and fever. Pharyngitis can be viral or bacterial. The most common and clinically significant bacterial cause of acute pharyngitis are group A beta-hemolytic streptococci.

Patient Information

Pharyngitis is the inflammation of the throat (pharynx). Pharyngitis is most often caused by viruses, but can also result from bacterial infection. The main symptom is a dry and sore throat. Other common symptoms include fever, swollen lymph nodes in the neck, cough, headache, pain in the ears and hoarseness. The treatment depends on the cause.

References

Article

  1. Mostov PD. Treating the immunocompetent patient who presents with an upper respiratory infection: pharyngitis, sinusitis, and bronchitis. Primary care. Mar 2007;34(1):39-58.
  2. Kushawaha A, Popalzai M, El-Charabaty E, Mobarakai N. Lemierre's syndrome, reemergence of a forgotten disease: a case report. Cases journal. 2009;2:6397.
  3. Alcaide ML, Bisno AL. Pharyngitis and epiglottitis. Infectious disease clinics of North America. Jun 2007;21(2):449-469, vii.
  4. Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. Mar 24 2009;119(11):1541-1551.
  5. Gerber MA. Diagnosis and treatment of pharyngitis in children. Pediatric clinics of North America. Jun 2005;52(3):729-747, vi.
  6. Shaikh N, Swaminathan N, Hooper EG. Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. The Journal of pediatrics. Mar 2012;160(3):487-493 e483.
  7. Wagner FP, Mathiason MA. Using centor criteria to diagnose streptococcal pharyngitis. The Nurse practitioner. Sep 2008;33(9):10-12.
  8. Centor RM, Allison JJ, Cohen SJ. Pharyngitis management: defining the controversy. Journal of general internal medicine. Jan 2007;22(1):127-130.
  9. Group ESTG, Pelucchi C, Grigoryan L, et al. Guideline for the management of acute sore throat. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. Apr 2012;18 Suppl 1:1-28.
  10. Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. The Cochrane database of systematic reviews. 2006(4):CD000023.

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Last updated: 2017-08-09 17:41